Efficacy Analysis of Unilateral Biportal Endoscopic in the Treatment of Degenerative Lumbar Spinal Diseases

目的：探讨单侧双通道内镜下治疗腰椎退行性疾病的临床疗效。方法：分析2021年8月至2022年8月通过单侧双通道内镜下治疗的83例腰椎退行性疾病患者(男性38例，女性45例)，包括腰椎间盘突出症21人、腰椎管狭窄症42人、退变性腰椎滑脱症20人。所有患者均行单侧双通道内镜下腰椎管减压术，双侧神经根症状者行单侧椎板切除双侧减压术，其中部分突出合并钙化、严重狭窄伴不稳及滑脱患者行镜下融合内固定术。记录患者手术平均时间、术中出血、下床活动时间、术后住院治疗时间及并发症等情况，术前、术后次日、术后1月、3月和末次随访时腰痛及腿痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)，以及末次随访中改良Macnab标准对临床疗效进行评估。结果：所有病人均顺利完成手术。平均手术时间为(131.69 ± 21.83) min、术中出血量(118.55 ± 21.65) mL；术后(1.70 ± 0.69)天佩戴腰围下床活动；平均术后住院天数为(4.28 ± 1.10)天。在随访期间全部患者腰腿痛VAS评分及ODI指数均较术前显著降低。末次随访中的改良Macnab标准：优69人、良11人、可3人，优良率为96.4%。共发生并发症7例，发生率为8.4%。结论：单侧双通道内镜技术治疗腰椎退行性疾病的临床疗效较好，手术创伤及并发症较少，是治疗腰椎退行性疾病的一种安全有效的手术方式。Objective: To investigate the clinical efficacy of unilateral biportal endoscopic (UBE) in the treatment of degenerative lumbar spinal diseases. Methods: 83 patients (38 males and 45 females) with degenerative lumbar spinal diseases were treated with UBE from August 2021 to August 2022, including 21 patients with lumbar disc herniation, 42 patients with lumbar spinal stenosis, and 20 patients with degenerative lumbar spondylolisthesis. All patients underwent unilateral biportal endoscopic lumbar decompression, and unilateral laminectomy with bilateral decompression for those with bilateral radicular symptoms, endoscopic interbody fusion and percutaneous pedicle screw fixation was performed for some patients with lumbar disc herniation combined with calcification, severe stenosis with instability and spondylolisthesis. The mean operation time, intraoperative bleeding, time to ambulation, postoperative hospital stay, and complications were recorded. The Visual Analogue Scales (VAS) for pain in low back and legs and Oswestry Disability Index (ODI) at preoperative, on the day after the operation, one month, three months, and the last follow-up, as well as modified Macnab criteria were used to assess clinical efficacy. Results: All patients successfully completed the surgery. The average operation time was (131.69 ± 21.83) minutes, and the intraoperative blood loss was (118.55 ± 21.65) mL. Patients were able to get out of bed and move around with a lumbar belt at (1.70 ± 0.69) days postoperatively. The average length of hospital stay after surgery was (4.28 ± 1.10) days. The ODI, VAS leg and VAS low back scores significantly improved after operation throughout the follow-up period. According to the modified Macnab criteria, the final outcome was excellent in 69 cases, good in 11 cases and fair in 3 cases, and the excellent and good rate was 96.4%. Seven complications occurred in total, and the incidence rate was 8.4%. Conclusion: UBE is a safe and effective procedure for the treatment of degenerative lumbar spinal diseases, with good clinical efficacy and less surgical trauma and complications.